Brain death determination: the imperative for policy and legal initiatives in Sub-Saharan Africa.


The concept of brain death (BD), defined as irreversible loss of function of the brain including the brainstem, is accepted in the medical literature and in legislative policy worldwide. However, in most of Sub-Saharan Africa (SSA) there are no legal guidelines regarding BD. Hypothetical scenarios based on our collective experience are presented which underscore the consequences of the absence of BD policies in resource-limited countries (RLCs). Barriers to the development of BD laws exist in an RLC such as Kenya. Cultural, ethnic, and religious diversity creates a complex perspective about death challenging the development of uniform guidelines for BD. The history of the medical legal process in the USA provides a potential way forward. Uniform guidelines for legislation at the state level included special consideration for ethnic or religious preferences in specific states. In SSA, medical and social consensus on the definition of BD is a prerequisite for the development BD legislation. Legislative policy will (1) limit prolonged and futile interventions; (2) mitigate the suffering of families; (3) standardise clinical practice; and (4) facilitate better allocation of scarce critical care resources in RLCs. There is a clear-cut need for these policies, and previous successful policies can serve to guide these efforts.





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Publication Info

Waweru-Siika, Wangari, Meredith Edwards Clement, Lilian Lukoko, Simon Nadel, Philip M Rosoff, Violet Naanyu and Peter S Kussin (2015). Brain death determination: the imperative for policy and legal initiatives in Sub-Saharan Africa. Glob Public Health. pp. 1–12. 10.1080/17441692.2015.1094108 Retrieved from

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Philip Martin Rosoff

Professor Emeritus of Pediatrics

My main interests are clinical ethics with a concentration on the equitable allocation of scarce resources (rationing). In this area, I have done work on planning for pandemic influenza and allocation of drugs during shortages. Before retirement I played a major role in the Clinical Ethics Service at Duke Hospital and chair the hospital's Ethics Committee.


Peter Samuel Kussin

Professor of Medicine

The majority of my effort is devoted to clinical care of patients with advanced lung disease and teaching.

I spend four months a year in Eldoret Kenya working at Moi Teaching and Referral Hospital as part of The Duke Hubert Yeargan Institute for Global Health and AMPATH- a consortium of North American Medical Schools collaborating with Moi University School of Medicine and Moi Teaching and Referral Hospital. I work primarily in the intensive care unit and medicine wards. I am involved in broad range of research efforts in critical care and pulmonary medicine  in resource limited countries.

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